Key result
Inpatient 24-hour Holter monitoring changes treatment in ~13% of patients admitted without syncope or stroke.
Why the study?
Inpatient Holter ECG use has been described solely for stroke and syncope, leaving its diagnostic value for other conditions in internal medicine unclear.
Does 24-h inpatient Holter ECG monitoring improve diagnostic yield for arrhythmias in hospitalized patients with conditions other than syncope or stroke?
Cohort (n=289)
No
Does 24-h inpatient Holter ECG monitoring improve diagnostic yield for arrhythmias in hospitalized patients with conditions other than syncope or stroke?
Inpatient 24-h Holter ECG monitoring has a 13% diagnostic yield for conditions other than syncope or stroke, particularly in patients with pre-syncope, palpitations, HFpEF, or baseline ECG abnormalities.
Answers are grounded in this paper and cite their sources.
May support targeted inpatient Holter use in select admissions; leaves open whether routine application improves outcomes.
Holter electrocardiography (ECG) assists in the diagnosis of arrhythmias. Its use in the inpatient setting has been described solely for the evaluation of stroke and syncope. Our aim was to assess its diagnostic value for other conditions in the internal medicine department. We included all hospitalized patients between 2018 and 2021 in a tertiary referral center. The primary outcome was a diagnostic Holter recording a new arrhythmia that led to a change in treatment. Overall, 289 patients completed a 24-h inpatient Holter ECG for conditions other than syncope or stroke, with 39 (13%) diagnostic findings. The highest diagnostic value was found in patients admitted for pre-syncope (19%), palpitations (18%), and unexplained heart failure exacerbation/dyspnea (17%). A low diagnostic yield was found for the evaluation of chest pain (5%). Heart failure with preserved ejection fraction (adjusted OR 2.3, 95% CI 1.1-5.4, p = 0.04), and baseline ECG with either a bundle branch block (AOR 4.2, 95% CI 1.9-9.2, p < 0.01) or atrioventricular block (first or second degree, AOR 5, 95% CI 2.04-12.3, p < 0.01) were among the independent predictors for a diagnostic test. Inpatient Holter ECG monitoring may have value as a diagnostic tool for selected patients with conditions other than syncope or stroke.
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Freund et al. (2023) conducted a cohort in Conditions other than syncope or stroke (e.g., unexplained heart failure/dyspnea, palpitations, chest pain, pre-syncope) (n=289). Inpatient 24-h Holter ECG monitoring was evaluated on Diagnostic Holter recording a new arrhythmia that led to a change in treatment. Inpatient 24-hour Holter ECG monitoring yielded diagnostic findings leading to a change in treatment in 13% of patients admitted for conditions other than syncope or stroke.
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